Could Britain legalise cannabis?

More and more countries are legalising, or relaxing their rules around, cannabis consumption for both medical and recreational purposes. But how close is the UK to following suit?

The recent move by Home Secretary Sajid Javid to allow specialist doctors to prescribe medical cannabis has many wondering if Britain is already on the road to full legalisation.

Some 31 per cent of the UK strongly opposes this possibility. However, a larger portion—59 per cent as of October 2018—appears to be moving towards acceptance of recreational cannabis*.

Whether policymakers will follow popular opinion on this issue remains to be seen, but the UK can look to another part of the world to understand some of the effects of the liberalisation of cannabis policy. California’s medical market dates back to 1996, at which time millions of patients were able to obtain prescriptions for pain relief, appetite stimulation, epilepsy treatment, as well as muscle and motor issues.

"Twenty nine per cent of Californian adults have used cannabis in the last six months, and decreasing numbers are opposed to its use"

Recreational legalisation in California took effect on January 1, 2018 and the state now represents the largest recreational cannabis market in the world. Investment capital is flooding the nascent for-profit industry in what some are calling a “green rush.” Today, any California resident or visitor can walk into one of about 350 retail shops, show ID, and access hundreds of cannabis products spanning edibles, vaping extracts, tinctures, concentrates, and dozens of strains of smokable cannabis flower. Millions of Americans use recreational cannabis to relax after work and at the weekend, to stimulate creativity and increase sociability, or to promote restful sleep.

A little over a year later, it’s too early to gauge the full effects of California’s recreational cannabis industry. However, certain trends are emerging. According to BDS Analytics, 29 per cent of Californian adults (21+) have used cannabis in the last six months (up from 23 per cent in 2014), and decreasing numbers are opposed to its use. Reliable data isn’t yet available on underage consumption in California, but a nationwide meta-analysis by New York’s Health Department on the subject concluded that, overall, legal liberalisation does not significantly affect underage use.

Though recent research suggests that cannabis does not have significant long-term effects on cognition and memory for developing brains, other problems for youth who use regularly—like the increased likelihood of mental health problems and dependence—remain.

Among adults, it's clear that attitudes in California are changing quickly. Says Arlene Guzman, a 34-year-old public relations professional in Los Angeles, “Never in a million years did I imagine myself discussing cannabis in a 'Mummy and Me' group.” But since legalisation, it’s come up many times. “I think when people see someone like me—a mum, university lecturer, member of my church and thriving professional—as a cannabis consumer, the negative stigmas begin to break down.”

"Calls to poison control centres due to children accidentally ingesting cannabis edibles are on the rise and adults can suffer health consequences too"

State regulation leads to better testing and standards, which helps assure consumers that they know what’s in the products they’re buying. Though the system remains imperfect, the cannabis industry is nonetheless one of the most regulated in the US today. Advocates have also pointed to a decrease in drug-related violent crime, increased state tax revenues, and better allocation of law enforcement resources to target the trafficking of more harmful drugs, as evidence that legalisation is a social good. Though the first year of tax revenue from cannabis sales in California has not met expectations due to a “bumpy rollout” of the new regulations, it is nonetheless a multi-billion-dollar industry that will add to state coffers and is forecast to continue growing. Additionally, decriminalisation measures and the expungement of non-violent cannabis-related records have helped countless individuals and reduced the burden on the criminal justice system.

While many see the positives of cannabis legalisation, others perceive more risk than reward arising from the new industry. For instance, many people would like to see an evidence-based test to determine driving impairment that would serve as an equivalent to alcohol’s breathalyser. The science of such a device is tricky, but biotech firms are working on it.

Lieutenant Brian Nevins of San Diego’s Sheriff Department explains that law enforcement is concerned by the elevated levels of THC (tetrahydrocannabinol, the component of cannabis responsible for the “high”) present in many of the products available in retail dispensaries today. Concentrated THC can have a different effect on the user than the “mellow high” often associated with cannabis, and officers are witnessing more unpredictable behaviour caused by concentrated THC consumption. He also noted that, “if you laid them next to one another, you couldn’t tell the difference between a Swedish Fish (an American sweet) and a marijuana gummy,” which poses problems to users and non-users.

Though high levels of cannabis consumption are not known to be fatal, calls to poison control centres due to children accidentally ingesting cannabis edibles are on the rise, and adults can suffer health consequences as well. As for the overall effect of legal cannabis, it’s too early to know. “We’re still in the petri dish stage,” Lt Nevins noted.

"Many of the direct fears associated with cannabis legalisation in California have not been realised"

Dr Brian Couey, a psychologist with the Hazelden Betty Ford treatment centre in California, echoed some of Lt Nevins’ concerns about newer, more potent cannabis products. While most people who use cannabis can do so responsibly, he said, “a certain subset of the population will develop dependency.” The mental health issues most frequently associated with cannabis dependency are mood instability and panic attacks. Psychosis, said Dr Couey, is a rarer, but worrisome, potential problem. Dr Couey has observed a slight increase in the number of patients seeking help for cannabis use disorder since recreational legalisation took effect in California.

Access in the UK Differs enormously from California, and any shifts in policy are likely to be incremental. Says Norman Lamb, MP for North Norfolk, “the government’s reform is a welcome, but small, first step. It will only help a minuscule number of people… Across the country, people who use cannabis for pain relief are being turned away by their GPs because the rules have been drawn so tightly about who can benefit.”

Dr Mike Barnes, a neurologist and rehabilitation physician who has advised Parliament on drug reform, says that securing reliable access for the patients who can most benefit from medical cannabis is key. “It’s going to be a slow business,” he said, “but changing the law from November 1 was a start.”

According to Dr Barnes, facilitating doctor education is another vital step in successfully implementing medical legalisation. To address the issue, he founded The Academy of Medical Cannabis, with the UK playing host to its first learning centre.

Many of the direst fears associated with cannabis legalisation in California and other states have not been realised. Many experts now agree that cannabis is not a gateway drug. Moreover, it is responsible for far fewer hospital admissions than alcohol (27,000 people a year are admitted to hospital for cannabis-related complaints in the UK, while alcohol-related hospital admissions reached 1.1 million in 2017*), and studies show that, at least in the US, cannabis users are on average employed at higher rates and earn more money than non-users.

However, Dr Jonathan Caulkins, public policy professor at Carnegie Mellon University and author of the book, Marijuana Legalisation: What Everyone Needs to Know, explains, “we won’t see the full effects until 25 years after national legalisation.” Dr Caulkins noted that, should the UK choose to legalise adult-use cannabis in the future, policymakers might do well to examine the way the market is structured. In other words, consider who’s allowed to produce, market, and sell it. The for-profit model, which characterises the recreational market in California, differs significantly from the government-supplied, non-profit, or cannabis club models.

“The fundamental objective of for-profit industry is to pump up profits and sales, and since the smaller number of daily and near daily users account for 80 per cent of consumption, that means the industry has a strong profit interest in promoting heavy use.” From a public health perspective, that’s risky, and Dr Caulkins suggests that the UK might do well to choose a different model.

It's clear that demand for cannabis exists. Luciana Lasorella, an artist and medical/recreational user living in San Francisco explained that, years ago, she understood that cannabis prohibition, just like alcohol prohibition, would end eventually. “Weed wasn’t going away,” she said, “and people were willing to spend money on it. The government was going to sniff that out, find a way to regulate it, control it in a way that was more beneficial to them. I didn’t see any reason why they wouldn’t.” It’s possible that the UK will one day face a similar situation.

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